Even as Diabetes Prevalence Triples, Rates of Serious Complications Drop

Between 1990 and 2010, the number of adults reporting a diagnosis of diabetes more than tripled, from 6.5 million to 20.7 million, outstripping the rate of total U.S. population growth during that period of from 178 million to 226 million. During those 20 years, however, rates of five diabetes-related complications among adults actually declined, according to a study published last month(www.nejm.org) in the New England Journal of Medicine.

In the study, researchers found that the incidence of lower-extremity amputation, end-stage renal disease, acute myocardial infarction, stroke and deaths from hyperglycemic crisis all declined during the designated time period.

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A CDC study published in the New England Journal of Medicine found that between 1990 and 2010, the number of adults with diabetes more than tripled.

At the same time, the researchers found that rates of lower-extremity amputation, end-stage renal disease, acute myocardial infarction, stroke and death from hyperglycemic crisis declined.

Researchers pointed to possible reasons for the drop in diabetes-related complications, such as an overall increased emphasis on integrated care management for patients with chronic diseases.

"These findings show that we have come a long way in preventing complications and improving quality of life for people with diabetes," said Edward Gregg, Ph.D., senior epidemiologist in the CDC's Division of Diabetes Translation and lead author of the study, in an April 16 press release.(www.cdc.gov)

However, Gregg noted, "while the declines in complications are good news, they are still high and will stay with us unless we can make substantial progress in preventing type 2 diabetes."

Breaking Down Two Decades of Data

CDC researchers analyzed data from the National Health Interview Survey, the National Hospital Discharge Survey, the U.S. Renal Data System and the National Vital Statistics System to identify trends in diabetes complications in the United States between 1990 and 2010.

The greatest relative decreases in complications were observed for acute myocardial infarction and death from hyperglycemic crisis, both of which declined by about two-thirds, according to the study. Moreover, the largest declines in complications in both absolute and relative terms were observed among those ages 75 and older, with the exception of end-stage renal disease, which declined among people ages 20 to 64 but not in those older than 64.

Study Outlines Mortality Risks From Complications of Diabetes

A Swedish study(onlinelibrary.wiley.com) involving nearly 21,000 people with type 2 diabetes who suffered a major diabetes complication found significant differences over time in mortality risk associated with each type of event.

For example, myocardial infarction and stroke carried the highest risks of death within a week after the event occurred. After one month, higher mortality risks were seen among those who suffered heart failure, renal failure or amputation.

The study, published in Diabetic Medicine, also revealed that a patient's life expectancy was highest after a stroke, myocardial infarction or heart failure, but was lower after amputation and lowest after renal failure. Smoking and poor renal function had the largest impact on reducing life expectancy.

Researchers pointed to possible reasons for the drop in diabetes-related complications, including an overall increased emphasis on integrated care management for patients with chronic diseases that incorporates team-based care, patient education in disease management and clinical decision-making support paired with enhanced patient self-management of risk factors.

Looking at Next 20 Years

Going forward, family physicians can continue to help patients battle diabetes and its complications by educating them about managing the condition.

"Make sure every patient with diabetes is well-educated on the risks associated with diabetes," said AAFP Health of the Public and Science Medical Director Jennifer Frost, M.D., noting that the Academy's FamilyDoctor.org website offers patient-education materials(familydoctor.org) that can help family physicians achieve this goal. "The patient-centered medical home provides a model for chronic disease management that will help primary care offices care for these patients."

The most important strategies to reduce the risk of diabetic complications are to treat lipid disorders and, of course, control blood sugar and blood pressure, Frost said. These strategies can include medications as well as lifestyle modifications, she added. To that end, American Family Physician offers up-to-date, evidence-based information on managing type 2 diabetes and preventing its complications as part of its AFP by Topic collection.

"We are doing a better job of helping our patients to manage their diabetes and, therefore, reducing complications," Frost said. "But we need to increase our efforts to prevent diabetes, as its prevalence continues to rise."